Picturing Healthy Living

Sleeping right, eating right, and exercising right—with an assist from the Cancer Center, one town used old technology to help: the camera

Collaborating with Norris Cotton Cancer Center researcher Anna Adachi-Mejia, PhD, students and residents of Woodsville, NH, utilized an innovative kind of photo-journalism to record their ideas about healthy ways to live to minimize the risk of cancer.

Dr. Adachi-Mejia composed several posters from the photographs and comments submitted by the student participants in the Photovoice project, grouped by topic area. This poster's message is: "Facebook: A barrier to physical activity and healthy sleep."

Called Photovoice and funded with an Institutional Research Grant from the American Cancer Society, the project put cameras and notebooks into the hands of high school and junior high school students, as well as senior citizens, to record and document healthy and not-healthy themes.

"We asked everyone who participated in the project the same questions: What makes it easy and hard for you to eat fruits and vegetables? To be active? To get enough sleep?" said Dr. Adachi-Mejia at a presentation of the Photovoice photography at the Horse Meadow Senior Center in Woodsville. "What came back was an amazing variety of pictures and accompanying comments of how those questions can be answered."

Surprising Themes Showing Healthy and Unhealthy Living

She grouped the photos and comments—totaling in the hundreds—into several broad themes. These included: animal companionship, benches and swings, balls, outdoor play, fruits and vegetables, gardening, indoor sports, cards, music, parks and paths, rivers and streams, sleep, social support, media, and Facebook.

Some of the themes surprised her, Dr. Adachi-Mejia told an audience of families at the Senior Center. "I hadn't thought that companion animals could so perfectly illustrate being active, like walking your dog, as well as healthy sleep," she said, showing a photo of a very contented sleeping cat. Other themes, such as Facebook, represent time spent without exercising or being active.

She created 18 posters built on the themes, and they were all hung on display in the Senior Center. "My goal is to put the themes out there to invite discussion and reflection," she said.

All of the project's participants were anonymous. At the Senior Center presentation, however, one participant, a student named Rainie, stepped forward to say: "[The Photovoice project] really got me thinking what I should do and why things make us active or not."

Innovative Participatory Photography

One Photovoice participant wrote: "Gardening is excellent exercise—a highly rated form of exercise."

Photovoice is a qualitative, participatory, and visual approach to research. Participants photograph their challenges, successes, and other observations of a specific problem and describe what they photographed and why. The technique has been used as a tool for community-based participatory research, and more than 188 Photovoice-based studies have been published to date, including eliciting perspectives from breast cancer survivors and tobacco users. Photovoice studies have also been used to identify health-related themes such as children's perceptions about road traffic safety, community members' insights on the influence of their town environment on physical activity, and older Asian immigrants' views of cardiovascular health.

"I learned that Photovoice is a great technique for the Cancer Center," Dr. Adachi-Mejia said. "Photos and writing together really bring out strengths in people and some really interesting ideas."